Texas Administrative Code
Title 22 - EXAMINING BOARDS
Part 9 - TEXAS MEDICAL BOARD
Chapter 187 - PROCEDURAL RULES
Subchapter J - PROCEDURES RELATED TO OUT-OF-NETWORK HEALTH BENEFIT CLAIM DISPUTE RESOLUTION
Section 187.89 - Notice of Availability of Mandatory Mediation

(1) Except in the case of an emergency and if requested by an enrollee, a facility-based physician shall, before providing a medical service or supply, provide a complete disclosure to an enrollee consistent with the notice requirements of § 1467.051 of the Texas Insurance Code, that:

(2) Failure to provide notice under this section shall not subject a licensee to disciplinary action.

(1) A facility-based physician who bills a patient covered by a preferred provider plan or a health benefit plan under Chapter 1551 of the Insurance Code that does not have a contract with the facility-based physician shall send a billing statement to the patient that contains a conspicuous, plain-language explanation of the mandatory mediation process under Chapter 1467 of the Insurance Code if the amount for which the enrollee is responsible to the physician, after copayments, deductibles, and coinsurance, including the amount unpaid by the administrator or insurer, is greater than $500 .

(2) The written notice shall include a reference to TDI's website about the mediation process - http://www.tdi.state.tx.us/consumer/cpmmediation.html.